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Reimbursement |
Bone strength assessment with Omnisense 8000S may be a covered service,
if it meets the requirements established by Medicare and private payers.
It is always recommended that you check with your local Medicare contractors
and private health plans regarding their local coverage policies.
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| Coding Requirements |
Codes are necessary for physicians and freestanding clinics
to report their services and procedures. Accurate coding may
lead to faster processing of submitted claims. In the absence
of a national coding policy it is advisable to check with your
local Medicare contractors or private insurance plans regarding
their accepted coding policy. A submission for payment requires
two codes for each procedure, a diagnosis code (ICD-9-CM) and a procedure code (CPT).
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| ICD-9-CM |
To comply with Medicare and third-party payer requirements,
claim forms must indicate the ICD-9-CM code or codes that
describe the principal diagnosis responsible for the patient's condition.
Sunlight has compiled a suggested list of ICD-9-CM codes that may relate to the
Omnisense 8000S bone strength assessment test.
Some carriers may have a specific list of ICD-9-CM codes.
It is advised that you contact your local carrier to obtain its current policy.
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| CPT Coding |
Physicians' Current Procedural Terminology (CPT), Fourth Edition,
is a listing of descriptive terms and identifying codes for reporting
medical services and procedures that physicians and other medical
professionals perform. The purpose of CPT is to provide a uniform
language that accurately describes medical, surgical, and diagnostic
services, thereby serving as a means for nationwide communication
among physicians, patients, and third parties. The CPT code used for
bone assessment with Omnisense is CPT Code 76977 (Ultrasound bone
density measurement and interpretation, peripheral site(s), any method).
CPT is a trademark of the American Medical Association (AMA).
The AMA assumes no liability for the information contained herein.
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| Billing Requirements: Documentation |
Documentation is the key to providing a carrier with the information
necessary for making a decision whether to approve or deny a claim.
Essential medical information should include documentation that Sunlight
Omnisense™ 8000S was used to assess the patient's bone strength
in accordance with approved indications.
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| Insurance Procedures |
Sunlight has prepared a list of procedures for insurance coverage for patients
covered by Medicare and patients covered by private insurers.
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The coding, coverage, and payment information contained herein is gathered
from third party sources and is subject to change. The codes listed are
possible coding options. It is always the provider's responsibility to
determine and submit appropriate codes, charges, and modifiers for the
services that are furnished. Providers should contact their local payers
for specific information on pertinent coding, coverage and payment policies
before a claim is submitted. Sunlight Medical Inc. cannot guarantee success
in obtaining payments for medical services.
Click here to return to the 8000S product page
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